Provider Demographics
NPI:1639451735
Name:WOMEN'S COACHING & COUNSELING
Entity Type:Organization
Organization Name:WOMEN'S COACHING & COUNSELING
Other - Org Name:VICTORIA JEAN HAAG
Other - Org Type:Other Name
Authorized Official - Title/Position:THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:VICTORIA
Authorized Official - Middle Name:JEAN
Authorized Official - Last Name:HAAG
Authorized Official - Suffix:
Authorized Official - Credentials:RN, MS, LCMFT
Authorized Official - Phone:316-250-9057
Mailing Address - Street 1:8220 E OXFORD CIR
Mailing Address - Street 2:#17203
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67226-1863
Mailing Address - Country:US
Mailing Address - Phone:316-262-5253
Mailing Address - Fax:316-613-2498
Practice Address - Street 1:421 E 3RD ST N
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67202-2509
Practice Address - Country:US
Practice Address - Phone:316-250-9057
Practice Address - Fax:316-613-2498
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-14
Last Update Date:2011-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS102106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS200429060BMedicaid